Scott Webb (Host): Men of a certain age, and I am in that group, often experience an enlarged prostate, also known as benign prostatic hyperplasia, and the symptoms are well annoying and definitely affect our quality of life. Joining me today to tell us about a revolutionary procedure to treat BPH, called Aquablation is Dr. Jaspreet Singh. He's the Co-Director of Men's Health and Urology Services at Montefiore St. Luke's Cornwall This is Doc Talk presented by Montefiore St. Luke's Cornwall. I'm Scott Webb.

Dr. Singh, it's always nice to have you on. Today we're going to talk about benign prostatic hyperplasia, and I think we'll probably end up abbreviating that BPH just because it's easier to say. But essentially what we're going to talk about today is this new treatment option, aquablation. But before we get there, tell us about BPH. What is BPH? Who has BPH? You know, maybe what are some of the risk factors? That kind of thing.

Jaspreet Singh, DO: Yeah, so as you mentioned, Scott, benign prostatic hyperplasia, BPH, you know, it's a non cancerous condition that causes the prostate gland to enlarge as a man gets older. In fact, what we know epidemiologically, by the time a man is 70 years of age, about three out of four men are going to have some urinary changes that are associated with BPH.

And, you know, what's happening throughout this whole process as a man is aging is that, cells in the prostate, they overgrow and, anatomically speaking, the prostate resides or sits right next to the bladder. The urinary channel leaves the bladder, runs through the prostate and then obviously out of the urethra.

And so as the prostate enlarges, it becomes this nuisance of a gland that can obstruct or block the drainage of the bladder and there's several associated symptoms which we'll get to in a second, but, you know, you asked me what are the risk factors and unfortunately, it's the three risk factors we have no control over.

Uh, one is being a guy, two is getting older, and three is genetics. Man, that really is, you know, the three risk factors of having BPH.

Host: Right. Yeah. And I'm 56, Doctor. So you use the word nuisance there, that's how I would describe the enlarging of the prostate as we age, just normal enlargement and the nuisance part of it. So maybe, you know, before we get to aquablation, how has BPH traditionally been treated?

Jaspreet Singh, DO: Yeah, so, you know, many men, and this is a very interesting fact to share that, two out of three men who are experiencing changes from BPH will never seek any therapy or intervention, and I think a lot of it is due to just kind of relaying and accepting it, or maybe justifying it, oh, it's part of the aging process.

But BPH definitely, or the symptoms that are associated with BPH, can really affect the quality of life. And that can include just difficulty urinating, stop and go, urgency, you know, going on a trip and making sure all the bathrooms are mapped out, perhaps waking up several times a night, waking up tired the next day.

And so, you know, many men will resort to changing their lifestyle, avoiding things like caffeine or, cutting down what they're drinking. They make these lifestyle modifications and that really should be the first step. I talk to my patients and, you know, if they're having a pot of coffee by the time it's 11 o'clock in the morning, and then complain to me that they're constantly go to the bathroom, obviously you have to change that. But, a lot of people will already kind of do that first step and then they'll talk to their medical doctor and medications are typically the first line treatment. But, 30 percent of men who take medications will have side effects, and that could be as serious as dizziness, lowering the blood pressure, , and there are drug interactions.

Many men who have other medical problems will have side effects that are related to the combination of multiple meds. Similarly, about 25 to 30 percent of men, by the 12 months of taking medication, will notice the efficacy declines, and so they're failing medications. And so, after medications, that's when we talk about surgical intervention. And typically, the kind of quote unquote gold standard, which has been in existence over the last three decades is something called the transurethral resection of prostate or a TURP.

Host: All right. Yeah. So as you say, that has been the gold standard, but it, I was reading about aquablation. I thought, well, this seems like maybe it could become the gold standard. So tell us about aquablation in the treatment of BPH. Seems like it's kind of a newer treatment option and how's it going so far?

Jaspreet Singh, DO: Really excited to share with the listening audience, aquablation. So it was first FDA approved, back in 2017 in the United States. And what we're using, and this is really what the next frontier of medicine entails, is this whole concept of using artificial intelligence, using robot, and integrating that in everyday clinical medicine.

And so what aquablation does is it uses high pressure water jet to be able to remove that prosthetic growth, where traditionally we talk about a TURP or, you know, you may have come across a laser therapy or a steam therapy for prostate enlargement. They all use heat or ablative type of technology.

And so, there are downsides to using heat to the prostate. There is associated side effects, sexually speaking. And that may be another reason why men don't pursue any treatment is they don't want to, you know, change one problem or exchange one problem for another. But what we're using is a, this high pressure jet. Think about a power washer using to clean the driveway.

Host: That's what I'm picturing in my head. I'm picturing. Yeah.

Jaspreet Singh, DO: That's exactly what is a high pressure, like a waterpik dental floss. Think about it that way, where it's very precise. It's delivered through a robotic technology without cutting the patient open and everything through the urethra where we're able to precisely remove this prosthetic growth. Now, alkyl ablation has been out for the last seven to eight years, but they just introduced a new technology called a hydro system, which is now allowing the integration of artificial intelligence

So what we've done now with this upgrade of the technology is that it allows real time feedback to the surgeon and saying, hey, listen, you know, take this into consideration. These are the margins that we should be resecting. And it really assists the surgeon to deliver the best treatment possible in the operating room.

Host: Yeah, it's really amazing and you're really speaking my language here. We're talking, you know, robots and artificial intelligence, so it does feel pretty cutting edge, like the future, you know, of treating BPH. How about from the patient's perspective in terms of what they experienced through this, recovery process, that kind of thing?

Jaspreet Singh, DO: Again, we're going to compare it to the gold standard, I guess, the transurethral resection of prostate. Now, typically that procedure is done under general anesthesia. That procedure, typically patients spend, you know, a couple of days in the hospital, a catheter for about a week. And anytime you're cutting the prostate, there's a risk of bleeding.

And now when we look at aquablation, which kind of falls under the minimally invasive to approach to treat BPH. It is a procedure done under anesthesia. It's done at the hospital. Everything's transurethral, there are no cuts that need to be made, and I, I make that a point because typically men who have significant prostate enlargement, and there's a category of how big prostates can be, mild enlargement, moderate, and severely enlarged, typically men who have severely enlarged prostates are not even a candidate for the TURP just because their prostate is too big.

And unfortunately then have the only other option is to go to the operating room to cut them open to remove this prosthetic growth. So, aquablation has really bridged that gap between treating, you know, any size prostate from mild all the way up to severely enlarged because of the fact that the aquablation allows that water pressure, the water jet to ablate tissue, endoscopically.

The procedure itself is about an hour as comparatively with TURP or an open procedure can be significantly longer than that. Patients spend overnight in the hospital. And, depending on the size of the prostate, will need a catheter after the procedure, typically 48 to 72 hours, which then gets removed in the office.

The clear advantage to minimally invasive procedure in this fashion is that your recovery time is much lower, right? So because there's no physical incisions, everything is transurethral. Most patients are back to the physical routine, you know, within 7 to 10 days, uh, which is fantastic.

Host: Yeah, it's amazing. I love when I'm hosting these and I hear that, you know, basically the future is here now, we talked earlier, you used the word nuisance and, you know, guys of a certain age understand exactly what you mean. They're nodding their heads. Yes, it's a nuisance doc, but you're also, you're also saying in the same breath, most men don't speak with their providers, whatever the reasons are.

And I just want to give you a chance here at the end, final thoughts, takeaways about aquablation, treating BPH and how we don't have to suffer.

Jaspreet Singh, DO: Yeah, so, I think you already started that summary. A lot of us understand, a lot of us men understand that things are going to change as we get older. As what studies show, most of us kind of ignore the symptoms until it's too late, perhaps, not being able to urinate one day or needing a catheter or some sort of other sequela, UTIs, that kind of stuff.

So, don't wait. Yes, traditionally, we were always fearful of the side effects to prosthetic surgery, whether it be sexual function or physical recovery, we've been able to mitigate that now. You know, this technology is here long term. We're looking at BPH tissue right now. There are studies that are looking at how to even take care of prostate cancer in the future.

So this technology, aquablation, which so excited to bring to the local community here at Montefiore St. Luke's. The system, the hydro system, is the first one in New York State that St. Luke's was able to acquire. And I'm really excited to bring this to the community, this technology, and really why wait to restore your normal quality of life, and really want to get that sooner than later.

Host: Yeah, that's well said. I mean, that's really what it comes down to is quality of life. And for those of us who wake up at three o'clock in the morning, like someone set an alarm for us, you know, to use the bathroom, it all makes sense. It all adds up. And as always, you're the best. So, thank you so much for your time today.

Jaspreet Singh, DO: I appreciate you having me, thanks.

Host: And visit MontefioreSLC.org for more information about urology services. And if you found this podcast to be helpful, please be sure to share it on your social channels and be sure to check out all the other Doc Talk episodes. This has been Doc Talk, the podcast from Montefiore St. Luke's Cornwall Hospital. I'm Scott Webb. Stay well.